Anticoagulation and genicular RFL (cooled)

[thecentral09]

Hey guys, what is your consensus for holding anticoagulation for genicular RFL. I don't have much otrho backup for hemearthrosis or anything like that, and would wonder your input. I am currently holding anticoagulants and holding off if plt count less than 80k, your thoughtS?

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[cbest]

3 of my 4 cooled RF knees have been on anticoag. One patient had a bruise at the inferomedial site that got better in about a week otherwise no issues. Small n but so far no issues.

 

[paindoc007]

Continue AC.

 

[pastafan]

Hemearthrosis from genicular RFA? I stay out of the joint. Only do thermal, do not hold anticoagulants.

 

[thecentral09]

Hemearthrosis from genicular RFA? I stay out of the joint. Only do thermal, do not hold anticoagulants.

Its been reported more than once. I am also pretty sure I am out of the joint, but I see some pretty mangled knees. Thank you all for the input

 

[painfree23]

Do you do rfa at 80 degrees for 90 seconds?
Also, do you just bill this as 3 peripheral nerve rfas?

 

[pastafan]

Do you do rfa at 80 degrees for 90 seconds?
Also, do you just bill this as 3 peripheral nerve rfas?

Don't know who you are asking but I do 80 degrees for 120 seconds usually with 20 gauge needles. Most get a solid 9-12 months but some get a few years. I have a couple of patients that are still pain free at 32 months. Great procedure for the patient.

 

[painfree23]

Don't know who you are asking but I do 80 degrees for 120 seconds usually with 20 gauge needles. Most get a solid 9-12 months but some get a few years. I have a couple of patients that are still pain free at 32 months. Great procedure for the patient.

Wow that's awesome. So not pulsed? Heard some ppl say pulsed is safer. Steroid?

 

[pastafan]

No steroid.

I would be interested in data, if it exists, regarding pulsed. For those patients with insurance that won't cover procedure that would be an option otherwise there is no reimbursement for pulsed.

 

[painfree23]

No steroid.

I would be interested in data, if it exists, regarding pulsed. For those patients with insurance that won't cover procedure that would be an option otherwise there is no reimbursement for pulsed.

That's true on the reimbursement. Typically Do u bill it as 3 separate peripheral nerve blocks? Then 3 separate peripheral nerve RFA?

 

[pastafan]

Billing issues discussed in private forum.

 

[pain_doc_]

I have done a few on anti-coag, haven't had any bleeding issues, usually have the knee wrapped in coban afterwards